UNIVERSAL ACCESS TO AIDS SERVICES BY 2010 OR A LOOMING GLOBAL EMERGENCY FOR AIDS FUNDING?

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The Replenishment of the Global Fund to Fight AIDS, Tuberculosis and Malaria: a briefing and call to action by TAC

The Global Fund to Fight AIDS, Tuberculosis and Malaria (the Fund) is less than 10 years old. The third Voluntary Replenishment Pledging Conference will be held in New York on 4-5 October 2010. This conference, chaired by UN Secretary General Ban Ki-Moon, is an opportunity for government and private donors to pledge funds that will finance the Fund’s work over the next 3 years.

The pledging Conference will be held 2 weeks after the UN MDG (Millennium Development Goals) Summit, and it is expected that several governments will announce their pledges to the Fund at that Summit, which starts on 20 September.

Secure financing has saved five million lives – now is not the time to stop!

Since it was created in 2002 the Fund has grown dramatically; it is now the major source of external financial support for programmes tackling AIDS, TB and malaria. The Fund has been able to demonstrate remarkable results by funding programmes in 144 countries; these have already saved more than 5.7 million lives, and it is estimated that every day 4,000 deaths are prevented.

The Fund has achieved these unprecedented results by funding programmes that have scaled up services which include:

The Fund has calculated 3 scenarios for the resources it needs to raise at the Replenishment Conference: $13 billion, $17 billion, $20 billion. Globally activists and health experts agree that the ambition must be to meet the highest scenario: $20 billion. This will enable the Fund to continue the level of programming already underway, and to support more programmes that would set the world on track to meet the MDGs. It has been calculated that a full replenishment would support programmes over the next 3 years that would:

• Put 7.5million people on ART
• Deliver TB treatment to 6.8m people annually
• Get close to eradicating mother to child HIV transmission by 2015
• Hit the malaria MDG target (to halt and reverse the spread of malaria by 2015) ahead of schedule
• Contribute to improvements in health system strengthening and maternal and child health

At the current time there are no indications that the Fund will receive the full $20billion. In fact there are serious concerns that the Replenishment may not even hit the lowest scenario - $13 billion. This would mean that the budget would be flat-lined and the Fund would have to cap future funding Rounds. This would mean a new tsunami of HIV-related deaths across the world in the years ahead – just at the time when we have begun to make inroads against HIV.

What can we do?

Through demonstrations, meeting elected officials, policy makers and other influential people, writing letters and emails, and other tactics, TAC members and supporters can seek to change the decisions that rich donor governments are making about their contributions to the Fund, and to ensure that all donors contribute their fair share. Unfortunately, the global recession is being used as an excuse for donor governments to step back from their previous promises. But these excuses simply don’t make sense. Most donor governments have agreed to increase spending on overseas aid so that they contribute 0.7% of their country’s Gross National Income. This means that they should have ring-fenced their budgets for development. And the argument that massive cuts in development budgets are necessary simply doesn’t make sense when rich countries were able to find $700 billion to bail out the banks when markets collapsed and continue to find billions of dollars to prosecute the war on terror.

Naming the key countries

Partnership is fundamental to the fight against AIDS, TB and malaria. We insist that low and middle-income countries need to do much more to fund the health of their own citizens, as well as putting in place the right policies and laws, and stopping corruption and misuse of funds. But even whilst we say this, there is a moral duty on the richest countries of the world to fill the gap—the investments of all partners must increase.

At this point, the most important countries for TAC members and supporters to focus on are:

The USA: As the richest donor country the USA is the largest contributor to the Fund, and also supports important AIDS programmes through its own bilateral programme PEPFAR (the President’s Emergency Plan for AIDS Relief). It would be a very important signal of support for the USA to make a multi-year pledge for the first time. This would mean that the Fund can make firmer long-term plans – especially if other donors follow this approach. 101 members of the US Congress (led by Congresswoman Barbara Lee) have called on their government to do this. It is essential that the US does not take money out of PEPFAR to fund the Fund. Both PEPFAR and the Fund have played a central role in supporting AIDS programmes in South Africa and beyond.

The USA needs to contribute at least $6 billion to the Fund over the next 3 years.

Germany is the third biggest donor, having pledged $1.2 billion since 2002. But now the German government‘s support for effective, multilateral aid in the fight against the three diseases appears to be weakening. At an early Global Fund Replenishment meeting they stated that they had strong support for the Fund and would increase their contribution. Less than a year later, they are breaking that promise, threatening to cut their current contribution level, rather than increasing to reach their fair share—and Germany is threatening only to pledge funds for one year.

Germany should pledge what civil society calculates as a fair share: $1.9 billion for the next 3 years.

Italy’s actions as a donor to the Global Fund are bizarre —they are the only donor not to have converted outstanding pledges to the Global Fund into actual contributions in cash—both for 2009 and 2010. They have not even budgeted for these pledges. This is outrageous. In addition, Italy is refusing to commit to a new pledge. They also haven’t bothered to respond to UN Secretary General, Ban Ki Moon, who wrote to ask President Berlusconi what had happened to the money.

Italy should immediately pay what it owes: $340 million, and pledge an additional $731million for the next 3 years.

Japan is the “founding father” of the Global Fund, yet its contribution is a lower proportion of its GNI than many other donors with smaller economies. Japan said it will make its commitment at the MDG summit and seemed likely to announce $800 million over 3 years.

Japan should at least double its contribution - and pledge what civil society calculates as a fair share: $1.8billion

The United Kingdom (UK) is the seventh biggest donor and has an existing pledge: £1billion ($1.6 billion) over 7 years (to 2015). It was the first donor to make a major multi-year pledge, which gave the Fund a secure future basis for planning. The UK elected a new government recently. While they say that development spending is safe, there is a Multilateral Aid Review (MAR) to decide which multilateral agencies will get more (or less) money. The MAR will report in early 2011 so the UK says it cannot make a pledge on October.

The UK should reiterate its support for the Fund, and make a new pledge in early 2011 (after the MAR reports) of at least an extra £840million for the next 3 years.

Other countries matter too—Belgium, The Netherlands and Australia have in the past been strong supporters of the Fund and should be called on to renew and strengthen their commitments. In addition, new economic power houses such as China should accept their responsibility for global health.

Millions of lives are at stake. Concrete gains in reducing sickness and death are at risk. Time is short. TAC appeals to you to raise this issue in every way possible. Write to these government’s ambassadors in South Africa. Issue press statements. Sign on to this global petition: www.globalfundreplenishment.org/sign-on-letter/. Organise demonstrations. Send copies of your letters to us.

We are writing to thank you for meeting with the Treatment Action Campaign (TAC) during your trip to South Africa for the World Cup. We were impressed by your personal commitment to the HIV/AIDS crisis - and were very pleased to learn that the new coalition government in Britain remains strongly committed to international development and responding to the priority issues facing countries in the South. From our perspective, improving global health should remain a particular priority.

During your visit and meeting with members of TAC in Khayelitsha we discussed the replenishment of the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund), and we appealed to you to ensure that the UK government shows strong leadership on this issue. In particular we called on you to make sure that the UK doubles its commitment to the Global Fund during the current replenishment cycle (which concludes at the pledging conference on October 4-5.)

The UK played a central role in creating the Global Fund less than a decade ago. In that short time the Global Fund has proven itself as a powerful public-private partnership. It has delivered substantial support which poor countries have used to change the course of the some of the most devastating health problems they face. The results that the Global Fund have already achieved are unprecedented and remarkable, and clearly support the UK's interests and the priorities we discussed.

It is estimated that financing and support from the Global Fund has already helped save 4.9 million lives by providing antiretroviral drugs to treat 2.5 million people with HIV, and to prevent HIV transmission from 790,000 HIV-positive pregnant women to their babies; by providing treatment to 6 million people with active TB; and distributing 104 million insecticide-treated nets to prevent malaria, as well as treating 108 million cases of malaria.

And the Global Fund has done far more than simply respond to these three diseases. Global Fund investments have directly strengthened many aspects of poor countries' health systems by enhancing infrastructure, strengthening laboratories, and expanding human resources (for example since 2003 over 11 million health and community workers have been trained). This means that countries are able to deliver better, stronger services across the health sector, as well as tackling priority diseases.

And one of the clear impacts of the Global Fund's investment has been to tackle maternal and child mortality. It is beyond doubt that progress towards all of the health Millennium Development Goals (MDGs 4, 5 and 6) has been enhanced by the Global Fund's investments. In sub-Saharan Africa, HIV, TB and malaria are responsible for 52 percent of deaths among women of childbearing age. HIV is the leading cause of child death in hyper-endemic countries (including South Africa) and malaria alone accounts for 16 to 18 percent of child deaths in sub-Saharan Africa.

As we approach the MDG summit in September, the global commitment to improving maternal and child health is clear - and very welcome. And part of the way to meet that commitment will be to invest in proven global instruments, including the Global Fund. A strong Global Fund replenishment will send the signal that the world is serious about meeting the MDGs and honouring its commitments to the countries in greatest need.

In South Africa we are convinced that the direct support provided by the UK government, and your investments in the Global Fund, have been very important and supported our abilities to begin to turn the course of HIV, TB and Malaria. As you know, South Africa is the country with the highest burden of HIV in the world; nearly six million people are infected with HIV. According to official statistics more than three million people have died of AIDS in the last decade. The HIV epidemic has undermined development, deepened poverty and inequality. HIV is the major cause of child mortality, and a leading cause of maternal mortality. South Africa's health indicators have declines in recent years as a simple result of an unmanaged epidemic.

For a period the perverse response of our government - which we called 'AIDS denialism' - allowed HIV to rage out of control. But we now have a government which is firmly committed to delivering an effective response to HIV, and we are proud to be partners in that effort. Yet we all know that this effort cannot succeed without continued support from the UK government - and other donors - both directly and through increased investments in the Global Fund.

We appreciate that your government may have concerns about the sustainability of ever increasing donor funding for health and AIDS. So do we. As one of the foremost civil society organisations campaigning for AIDS treatment in South Africa and throughout Africa, we can assure you that we intend to do more and more to take action to ensure that our own governments invest in health and that we eliminate waste and corruption. But we also believe that health is a public good and a human right which requires stepped up international co-operation and assistance.

We firmly believe that the global response to AIDS, TB and Malaria, and the achievement of the MDGs are at a tipping point. The world cannot afford to squander the results that have been achieved so far. It is possible to turn the tide of the diseases of poverty, and to achieve the MDGs. The success of the Global Fund Replenishment will be central to this.

It is for this reason that, at this critical moment, we urge you to make sure that the UK government at least doubles it commitment to the Global Fund. Doing so will send a strong signal of confidence to other donors, and the UK could play a central role in leveraging substantial extra funds from others - especially other European countries and the US Government. This would be a brave and powerful signal from the new UK government.

We look forward to hearing further from you.

Yours truly

Ms Vuyiseka Dubula
General Secretary
Treatment Action Campaign

ENDS

Letter from UK Secretary of State Andrew Mitchell to TAC

Thank you for your letter of 12 August to the Secretary of State for Culture, Media and Sport, Jeremy Hunt MP, about the forthcoming replenishment of the Global Fund to fight AIDS, TB and Malaria. I am replying as the UK Secretary of State for International Development responsible for the issues raised.
I am grateful for your kind words about the role the UK has played in tackling these three diseases and in supporting the Global Fund.

The UK has already made a long term commitment to the Fund of up to £1 billion to 2015. This £1 billion pledge and our decision on the shape of the commitment from 2010 onwards will continue to be made on the basis of assessments of demand, performance and sustainable impact.

I wrote to the Executive Director of the Global Fund, Professor Michel Kazatchkine, on 9 June, and met him on 17 August, to let him know that DFID has launched a Multilateral Aid Review to look at core funding that DFID provided to multilateral agencies. The review will include an assessment of the relevance of the Global Fund to the UK’s objectives on poverty reduction and its ability to deliver results on the ground. The results of the Multilateral Aid Review will be an important element in any future funding decisions in respect of the Global Fund.

We are already one of the world’s largest funders tackling the three diseases through a variety of channels, including the Global Fund. We will continue to encourage others to honour their own pledges and encourage new donors to step up to the plate.

But we remain concerned about areas of performance which we want the Fund to address. Through our commitment we want to see the Fund get better at working with partner countries and achieving better value for money. The Fund needs to be able to show that it is not only effective but efficient in what it delivers. Despite impressive results, we want ongoing reforms to be implemented with pace and urgency.

Yours,

Andrew Mitchell

From the Rt Hon Andrew Mitchell PM
Secretary of State

ENDS

TAC letter to High Commissioners – sent to Ambassadors of Germany, Italy, Japan, the UK and the USA

His / Her Excellency High Commissioner

2 September, 2010

Your Excellency

We are writing to request a critical meeting prior to the MDG Summit at the UN 19-21 September.

The purpose of this meeting is for the Treatment Action Campaign (TAC) to urge your government to ensure that there is a successful replenishment of the Global Fund to Fight AIDS, TB and Malaria; by ensuring that the Fund receives $20billion to support life-saving programmes over the next 3 years. The Replenishment Conference is on 4 to 5 October 2010, and the outcome of this meeting will contribute significantly in the advancement of dialogue therein.

Your government has played a central role in securing effective AIDS programmes in South Africa and globally, and we look to you for your continued leadership on this issue. We look further to hearing from you to schedule a meeting at your earliest convenience.

Yours sincerely,

Vuyiseka Dubula
General Secretary
Treatment Action Campaign

ENDS

Reply to TAC’s letter to High Commissioners from the Japanese government

Thank you for showing your interest in the Japanese Government's assistance to the Global Fund. Apologies for this late response, since your letter has arrived at the Embassy only today.

Japan has been the proud originator of the Global Fund by taking up the
issue of infectious diseases for the G8 Kyushu Okinawa Summit in 2000 and helping it materialised as it is in 2002.

Therefore, we in the Embassy and the Head Office in Tokyo are quite aware of the importance of the Fund and its targets. We are currently on the right track towards realising our financial commitment to the Global Fund which we made in May 2008. Also constantly we have associated with the officials from the Secretariat of the Global Fund at the Head Office for the more efficient and effective operations. Needless to say, we will continue to play an important role in supporting the Fund in the range of a capacity available for the Government.

Regarding the meeting that you requested for, unfortunately I will be out of country most of the next week and seems difficult to set it up in time for the UN MDG Summit at NY starting at 20 Sep. We hope that this email will help you understand where we stand on this issue.

TAC and SECTION27 briefing on the financial transaction tax

A New Approach to Funding the Fight Against Disease?
Should we support a financial transactions tax (FTT) to fight AIDS, maternal mortality,
and extreme poverty?

A Briefing and Call for Action by TAC and SECTION 27

Funding for the Global Fund for AIDS, Tuberculosis and Malaria is under serious threat. In addition, the World Bank recently estimated that US$12.5 billion is needed annually to scale up effective nutrition programs globally. The UN Secretary General, Ban Ki-Moon says that an additional $42 billion needs to be spent on global health in order to meet the health-related Millennium Development Goals (MDGs). According to the Global Alliance for Improved Nutrition (GAIN) there is not enough money to fight malnutrition in poor countries. Recent WHO reports show that while progress has been made, the targets to achieve Universal Access to AIDS treatment, prevention and care will not be met in 2010. And health systems are crumbling.

Without a bold plan for financing health, the eight MDGs, agreed to by world leaders in 2000, will not be met by 2015. These targets will be missed because of a lack of global commitment and political will, not because of a lack of capacity. We believe the world can achieve these crucial goals on health, education, climate, sanitation, women’s rights, and poverty, and save millions of lives. It will require far more political will, greater accountability, democracy and activism.

And it will also require that an additional $100 billion be spent over the next 5 years.

Unfortunately at a time when the fight against unnecessary deaths from treatable, preventable illness and poverty needs more money we are in the midst of an economic crisis. Several wealthy countries have started shrinking their development assistance budgets - with more countries threatening the same. Some developing countries are also now showing signs of scaling back their own efforts and plans to improve health.

Cuts in funding and declining developing country ambition will threaten whatever fragile gains have been achieved since 2000. For example, over 4 million people now have access to life-saving HIV treatment, but much more is needed to ensure that the 10 million additional HIV positive people in urgent clinical need of treatment, also have access. In addition, a slowdown in funding will not save money – instead it would lay the basis for much more costly health and development challenges in the future.

It is not just the rich world that has suffered from the economic crisis. The impact on the developing world has been more severe: an estimated 46 million more people are living in poverty, global job losses could total 51 million. In poor countries, an estimated 200,000-400,000 more infants will likely die as a result.

From September 20-22 2010 the world’s leaders will gather at a High Level UN Summit, to attempt to ‘rescue’ the MDGs. But without a radical new approach to development finance, any effort at rescue will only add up to a half-measure.

What is needed?
Public outrage at the reckless and selfish conduct of the financial sector, as well as massive gaps in funding access to essential services all over the world, have sparked new momentum in support of a modest levy on financial transactions, called a ‘Financial Transactions Tax’ (FTT).

It is calculated that this tax could raise additional revenue—adding to traditional development assistance and national budgets—to help finance the fight against AIDS, maternal mortality, extreme poverty, climate change and other development challenges. And this tax would also curb the speculative activity in the financial sector that helped cause the economic crisis. In South Africa, such a tax could give the South African Revenue Board more control, outside of monetary policy and direct market involvement, over trading levels of the Rand.

The revenue raised by an FTT could be invested in domestic as well as global priorities, at a time when rising deficits and unemployment in wealthy countries are affecting millions.

It is estimated that a levy of 0.05% on all financial transactions could raise approximately $700 billion annually.

A smaller levy, only on wholesale currency transactions, at a rate of 0.005% would raise approximately $33 billion per year, if applied to the four major currencies (British sterling, the Euro, the Dollar and the Yen). Foreign exchange is the largest market in the world—worth $800 trillion a year—and it is the only area of the financial sector that has no taxation at all.

The global foreign exchange market is the largest (financial) market in the world and has grown 20% in 3 years . It’s now worth $4 trillion a day, and its turnover was 20% higher in April 2010 than in April 2007, turning over $1,000 trillion a year. Banks located in the United Kingdom accounted for 36.7% of all foreign exchange market turnover, followed by the United States (18%), Japan (6%), Singapore (5%), Switzerland (5%), Hong Kong SAR (5%) and Australia (4%).

How an FTT would work?
FTTs have already been in existence in a range of settings, so they have been well tested:
• In the UK a 0.5% tax on share transactions raises more than £3 billion each year, which then contributes to overall government revenue.
• In the US a small transaction tax has already been implemented to fund the Securities and Exchange Commission;
• In Belgium an FTT on the transfer of shares, bonds and other securities, at a rate of 0.5-1.7%, raised 147 million euro in 2005.
FTTs are feasible—and collection of revenue from an FTT would be automated, simple and inexpensive.

Support grows for an FTT
So far, proposals for an FTT have received widespread support from a range of European, U.S. and African leaders, as well as economists, business leaders, and civil society organizations. The infrastructure to administer an FTT is straightforward, and is basically in place in many countries, including South Africa so it would be relatively simple to collect the tax should they collect it. These proposals are being explored and developed in multiple fora around the world. For example:

- The High Level Task Force on Innovative International Financing for Health Systems Strengthening, co-chaired by former British Prime Minister Gordon Brown and World Bank Director Robert Zoellick, included a Currency Transaction Levy as a proposed mechanism to raise new funding for health systems strengthening;
- The Leading Group on Innovative Financing for Development — an intergovernmental forum with representation from around the world—established a Taskforce on International Financial Transactions for Development. An expert group has examined the feasibility of financial transaction taxes, including currency transaction taxes, and presented its report “Globalizing Solidarity: The Case for Financial Levies” in July 2010 ;
- Recent reports suggest that a group of 60 nations, which include France, Japan, the UK and South Africa, will propose that a multi-currency transaction tax is desirable, could be implemented internationally and that such a tax would be an important source of additional development finance. This group will next meet in mid-December in Tokyo; and
- Twelve countries among the 60 are heading up the project and appointed a panel of international experts last year to outline viable options. French President Nicolas Sarkozy plays a leadership role, and has stated that agreeing on a new Financial Transactions Tax will be a priority for France when it takes over as Chair of the G20 in November; France will be President of both the G8 and G20 in 2011.

What is needed?
Up to now it seems that it has been primarily developed country governments that have been discussing a proposed FTT. Yet the crisis of poverty and disease is mostly in the developing world. In addition, as we have explained, the worst effects of the global financial crisis that was catalysed by the financial sector are felt here. We believe it is time South Africa played a leadership role, including within regional and political bodies such as SADC, the African Union and NEPAD, in supporting calls for an FTT for health and development. South African support can dramatically accelerate political and technical efforts on an FTT.

The MDG summit will be attended by Deputy President Motlanthe, Health Minister Motsoaledi and others. We say that South Africa should state that progress on an FTT, to be used to raise funds for sustainable funding for health and development, is a major policy priority at the MDG Summit. Then, South Africa should partner with other G20 Members, particularly India, Brazil and China, to work for accelerated implementation of an FTT to be an issue to be agreed in November 2010 at the G20 Summit in Busan, South Korea.